Where can you find free vasectomy reversal when the average cost ranges from $5,000 to $20,000, depending on the complexity?
Get a deep-pocketed third party to pay most of the charges: your health insurance company.
How do you get insurance to pay for your vasovasostomy? Demonstrate that the microsurgical procedure is medically necessary.
What if you change your mind about having children and do not have a medically necessary reason? Cover the intended outcome instead, or take advantage of considerable tax savings associated with a High Deductible Health Plan (HDHP) combined with a Health Savings Account (HSA).
Vasectomy Reversal Insurance
In general, health insurance rarely covers vasectomy reversal because it is elective. If you want a free procedure, you will have to demonstrate that it is medically necessary: the surgery treats an illness, disease, injury, or condition, or its symptoms.
Getting to Pay
To get medical insurance to pay for vasectomy reversal, provide the company with a detailed letter of medical necessity.
Post-Vasectomy Pain Syndrome (PVPS) is one condition that might meet the criteria. Pain is a symptom the vasovasostomy might correct. However, you will probably have to try less invasive treatments first.
- Non-steroidal anti-inflammatory drugs
- Tricyclic antidepressants
- Regional nerve blocks near vas deferens
What Insurance
Asking what insurance covers vasectomy reversal is unlikely to lead to free surgery. The issuing companies have no legal responsibility to pay for the procedure because you changed your mind about having children.
Instead, have the urologists help you compose a letter of medical necessity to the claims underwriting department, including these critical elements.
- Patient name and member ID number
- SOAP Notes (Subjective, Objective, Assessment, Procedure)
- Summary of medical history and diagnosis
- Rationale for treatment
- How it treats PVPS
- Why is it consistent with the applicable standard of care?
- The reason pain therapy is insufficient
- Proposed operative report
- Appropriate ICD-10 and CPT codes
- Prognosis or expected outcome
BCBS
Likewise, asking whether Blue Cross Blue Shield (BCBS) covers vasectomy reversal is a poor strategy for free surgery. Instead, work with your urologist to craft the letter of medical necessity.
Blue Cross Blue Shield (BCBS) is a national federation of thirty-five independently owned and operated insurance companies that set their claims underwriting standards individually.
Send the letter of medical necessity to the specific (1 of 35) BCBS company issuing your policy. They are the final authority on the subject – not this article.
Medicaid
Once again, asking whether Medicaid covers vasectomy reversal will unlikely lead to free surgery. You have to establish the medically necessary reason with your urologist.
Medicaid covers many elective surgeries when the operation treats an illness, disease, injury, condition, or symptoms. A renewed desire to have children is insufficient.
Send the letter of medical necessity to the company administering claims for your Medicaid plan. Request pre-certification before going under the knife.
Cost With Insurance
The cost of vasectomy reversal with medical insurance comes close to zero (free) when your plan pays for the procedure in response to your letter of medical necessity. However, every healthcare plan includes patient expense-sharing features, which vary.
- Annual deductible
- Copayments
- Co-insurance
Most men do not have a medically necessary reason and should investigate three other insurance programs that make the procedure and its intended outcome more affordable.
HDHP Insurance
The cost of the vasectomy reversal procedure with high deductible health insurance can be close to 39% less than the average retail price of $8,700 – even when the plan does not cover the procedure.
A High Deductible Health Plan (HDHP) allows patients to pay for the surgery using a Health Savings Account (HSA). You can fund your HSA with pre-tax payroll contributions that save you money on three levies.
For instance, a California couple earning $100,000 realizes tax savings of 38.95%.
- Federal: 22%
- State: 9.3%
- FICA: 7.65%
An HDHP is also ideal for pregnancy, the intended goal of your surgery. You combine lower premiums with the opportunity to cover unexpected medical expenses using tax-favored HSA funds.
Disability Insurance
The cost of vasectomy reversal with short-term disability insurance is much lower when you include the intended outcome of the surgery: making your wife a new mother. The policy will not cover the procedure but could pay off handsomely with a successful pregnancy.
Short-term disability covers maternity leave when your female partner buys the coverage before conception, which means now! Most people find that the benefits of a planned event exceed the premiums by a substantial margin.
Hospital Indemnity Insurance
The cost of vasectomy reversal with hospital indemnity insurance is lower when the intended outcome includes a common side effect. Ten to fifteen percent of newborns begin life confined to an incubator in the Neonatal Intensive Care Unit (NICU).
Supplemental infertility insurance includes hospital indemnity policies that directly pay a cash benefit to the covered individuals for events stemming from your surgery.
- Mom’s hospital admission for labor, delivery, and recovery
- Newborn confinement in the NICU for specialized care
Final Thoughts
A minority of men can get free vasectomy reversal by having their health insurance cover the procedure. Compose a letter of medical necessity documenting the illness or symptom the surgery will correct.
Post-vasectomy pain syndrome is one condition that might pass muster with the underwriting department. However, most men do not have this condition.
Most men will have to pay to undo their vasectomy without insurance. Depending on your tax bracket, a high deductible plan that qualifies for a health savings account can reduce your out-of-pocket costs considerably.
Also, purchasing short-term disability and hospital indemnity insurance before conception is the best way to cover the intended outcome of your surgery and lower the costs of bringing home a new baby.
